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Endoscopic treatment with stabilized nonanimal hyaluronic acid/dextranomer gel is effective in vesicoureteral reflux
Göran Läckgren1, Erik Sköldenberg, Arne Stenberg
1Section of Urology, University Children's Hospital, Uppsala, Sweden. goran.lackgren@surgsci.uu.se
Insights
Endoscopic injection of stabilized nonanimal hyaluronic acid/dextranomer gel effectively treats vesicoureteral reflux in children, even those with bladder dysfunction. This minimally invasive treatment shows high success rates and resolves associated bladder issues in many cases.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Urodynamics
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Bladder dysfunction can complicate VUR management.
- Endoscopic injection of stabilized nonanimal hyaluronic acid/dextranomer gel is a recognized VUR treatment.
Purpose of the Study:
- To evaluate the efficacy of endoscopic stabilized nonanimal hyaluronic acid/dextranomer gel injection in children with VUR and concomitant bladder dysfunction.
- To assess the impact of this treatment on both VUR resolution and bladder dysfunction symptoms.
Main Methods:
- Retrospective analysis of 54 children with VUR and bladder dysfunction treated with endoscopic injection.
- Voiding cystourethrograms at 3 and 12 months post-injection to assess reflux.
- Long-term follow-up (7-12 years) including chart review for UTIs and bladder issues, plus postal questionnaires.
Main Results:
- Successful VUR treatment (cure) in 83% of children after 1-3 injections.
- Resolution of bladder dysfunction observed in 59% of patients.
- 83% of patients remained free of urinary tract infections post-treatment; the procedure was well-tolerated.
Conclusions:
- Endoscopic injection of stabilized nonanimal hyaluronic acid/dextranomer gel is effective for VUR in children with bladder dysfunction.
- Bladder dysfunction should not preclude patients from receiving this minimally invasive endoscopic treatment for VUR.
- The treatment demonstrates durable efficacy and safety in this pediatric population.
Purpose:
Endoscopic injection of stabilized nonanimal hyaluronic acid/dextranomer gel is an established treatment for vesicoureteral reflux in children. We performed a subgroup analysis to assess this treatment in reflux associated with bladder dysfunction.
Materials And Methods:
Of 308 consecutive children treated endoscopically with stabilized nonanimal hyaluronic acid/dextranomer gel for dilating vesicoureteral reflux 54 were observed retrospectively to have bladder dysfunction. Initial followup consisted of voiding cystourethrogram at 3 and 12 months after injection, with positive response defined as reflux grade 0 or I. At 7 to 12 years following treatment patient charts were checked for urinary tract infections and bladder dysfunction, and a followup survey (postal questionnaire) was administered.
Results:
A positive response to therapy (cure) was observed in 45 children (83%) after 1 to 3 endoscopic treatments. Concurrently, bladder dysfunction had resolved in 32 patients (59%). After the last stabilized nonanimal hyaluronic acid/dextranomer gel implantation 45 patients (83%) were free of urinary tract infections. Questionnaire results were similar to chart based findings. Stabilized nonanimal hyaluronic acid/dextranomer gel implantation was well tolerated, with no associated complications.
Conclusions:
Endoscopic treatment with stabilized nonanimal hyaluronic acid/dextranomer gel appears to be similarly effective in patients with vesicoureteral reflux with and without bladder dysfunction. These data indicate that bladder dysfunction should not be considered a contraindication to endoscopic treatment for reflux.
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